J Emerg Med
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Use of methohexital as an agent for moderate procedural sedation in the Emergency Department (ED) recently has increased. As a barbiturate, potential complications include respiratory and myocardial depression. We conducted a retrospective review of medical records and procedural flow charts for all use of methohexital in our ED during a 31-month period. ⋯ Complications occurred in 20.2% of patients and included oxygen desaturation, hypotension, hypoventilation, vomiting, tremor, and airway obstruction. All complications were transient and managed without sequelae. Use of concurrent parenteral opioid medications had no significant impact on success or complications.
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Infarction of the posterior cerebral artery may present only with signs of agitated delirium and an acute confusional state. In the absence of other prominent neurological deficits, this can be easily mistaken for toxic-metabolic encephalopathy, head trauma, post-ictal confusion, or a psychiatric disorder. Appropriate head imaging studies are important to detect an illness that might otherwise be missed and left untreated.
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Chylothorax is a rare entity with both traumatic and non-traumatic etiologies. Chyle depletion has significant nutritional, metabolic and immunologic consequences. We present a case of a patient with chylothorax who presented to the Emergency Department on numerous occasions with complications related to his chylothorax.
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Review Case Reports
Acute cerebellar ataxia in a toddler: case report and literature review.
Acute cerebellar ataxia (ACA) is an inflammatory CNS disease that is characterized by rapid onset of ataxia in a child under 6 years of age. Symptoms typically occur in association with a relatively benign viral illness and have been reported after vaccination as well. ⋯ The emergency approach should be focused on excluding more significant illnesses, such as meningitis or an intracranial mass lesion. Here we present a case of a young girl with ACA and review the relevant literature.